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11 Comments

1. One of the most informative articles to come about this blog. Thank you so much for your time and effort in sharing your obvious professional knowledge on this topic. This one will be in the keeper file for me. Stay well sir (s).

2. Vert good articles. Thank you

3. Given the difficulty opiod epidemic and the difficulty in obtaining prescription pain relievers, I find the “morphine bomb” information to be particularly useful.

   I’d like to know whether the “morphine bomb” is supposed to be taken orally, rather than injected. I assume that it is or that an injection would have been mentioned, but I’d like to be sure.

   1. Yes, the “morphine bomb” is taken orally. And we should have mentioned, there is no kind of “high” associated with it. It’s also not as effective as something like Percocet.

4. On the epinephrine and the lidocaine. When they are used together for local anesthesia it is because epinephrine is vasoconstrictive. It slows the absorption of the lidocaine allowing it to remain effective longer. It is never used on fingers, toes or the nose. Vasoconstriction in these areas could cause damage to the area from lack of blood flow.

   Lidocaine is typically painful to inject (it burns) and IMHO is often not needed prior to suturing as it is used to numb the area by injection. The actual act of pushing the needle for suturing is probably less painful and it doesn’t burn. I’ve sutured a number of people without using it and it worked okay. I had to suture my forehead once when I was without insurance. It was fairy easy to do in a mirror but tying the knots was a little more difficult.

   On the topical lidocaine, Vagisil is an OTC cream containing 15 to 20% benzocaine, a close relative of lidocaine. Vagisil is used for “feminine” itching. Benzocaine is useful for much more than that. Look it up. There is also a generic equivalent that is a bit cheaper.

   On the OTC pain meds. Recommended dosage has been reduced from previous years. It would seem that big pharma wanted you to take twice as much as you probably needed. Not that it would have anything to do with them selling twice as much and doubling their profits. Anyway, for more severe pain I see no reason to not take both ibuprofen and acetaminophen. Just alternate the times. Take the ibuprofen every six hours and the the acetaminophen 3 hours afterwards. Maintain that schedule and as the ibuprofen is starting to wear off the acetaminophen is kicking in. Know what you are taking and be familiar with the dosing as recommended for providers to prescribe. As a nurse I could not tell you how much and how often the doctor could tell you to take it. I could only tell you to follow the directions on the bottle. I know how the doctor would prescribe it.

   I would also be very cautious about using sterile water to mix with medications so they can be injected. Most medications that I know of that require mixing specify that normal saline be used. Sterile water can be very caustic when injected and I have seem tissue damaged from it.

   I didn’t get to read yesterdays article until today and would wonder about using antibiotics for pink eye. In a limited availability scenario it might be best to reserve these for more serious problems. Pink eye usually heals up just fine without treatment but is uncomfortable. It is also very contagious and good hand washing is essential.

   For those interested, Ebola is again reaching epidemic proportions in the Congo. The World Health Organization is trying out an experimental vaccine for it.

   1. Recent first person experience here on lidocain and epinephrine.
      Regarding the recent stupid “accident” that required many sutures (poly-irrigation line, box cutter and awkward position do not mix) the lidocaine shot was by far the most painful part of the experience. I’ve had lidocain used before and it seemed to me that much more was used this time. However, while no artery was breached, several veins were severed so the bleeding was quite profuse. The doctor specifically said that the shot would constrict the blood vesels and help control the bleeding so that they could suture the wound. It was either that or a tourniquet and they don’t like to use tourniquets on non-arterial bleeding.
      As a side note, I could have used a clotting agent to stem the bleeding, but they would have had to clean that out before they could suture the wound. The total elapsed time between cutting my forearm and the doctors sutures was about an hour and fifteen minutes. That’s not enough time to worry about a clotting agent on an extremity that direct pressure on the wound worked well. Perhaps if the wound had been in an area where direct pressure wasn’t as effective I might have considered a clotting agent, but I can hold direct pressure myself for an hour. I actually lost very little blood during the ordeal.

5. Thank you so much for your comments. We could have written so much more, but then the article would have been so much longer. We really wanted to focus on acquiring the supplies doctors would want to have to address the most common illnesses and injuries. No one should be injecting any lidocaine or epinephrine without significant training, which is beyond the scope of this article. The doctors teaching the austere medicine courses both recommended acquiring lidocaine and epinephrine.

   We’ll definitely study up on benzocaine.

   We’ve read about staggering acetaminophen and ibuprofen for improved pain management.

   Agreed on the pink eye antibiotics. Antibiotics will be precious. People will eventually learn which conditions will usually resolve on their own and save the antibiotics for more serious conditions.

6. Regarding lidocaine and epinephrine, I assume that the bottles come with clear instructions about how much powder should be used with the specific amount of water, correct?

   1. Our packet of lidocaine powder does not come with mixing instructions, and neither would the saline solution it needs to be mixed with. Everything is going to depend on your intended use. What strength do you need? Is it topical or injected? What other drugs are being used? These and other factors need to be taken into consideration.

      Same goes for epinephrine.

7. Grapefruit juice potentiates opioid analgesics (and some other drugs) by blocking certain enzymes that metabolize them. A cup of grapefruit juice taken 1-1.5 hours before the opioid provides the maximum effect.

   1. Opioid potentiation with grapefruit juice or anything else should only be undertaken with the care of a licensed physician.

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